Analysis of a multicomponent intervention intended to reduce levels of conflict and containment in inpatient mental health settings

Background Safewards is a multicomponent, evidence-based conflict and containment reduction intervention that has demonstrated effectiveness in general acute mental health settings.

Aim To evaluate the effect of Safewards in six wards of a regional medium secure forensic unit.

Methods A service evaluation was adopted incorporating a non-randomised controlled design to analyse the effects of Safewards on conflict and containment between and within wards. Adherence to the interventions was measured and informal feedback sessions with staff were conducted to explore views on the acceptability of the interventions.

Results Both between and within-ward analysis found no statistically significant benefit of Safewards. However, adherence to the interventions was poor due to prevailing operational priorities, including heightened acuity in the research sites, demands on staffing resources, criticism of the process of implementation and staff attitudinal barriers.

Conclusion The effect of Safewards in this setting cannot be determined without greater staff acceptance and adherence to the interventions. The success of Safewards will be sensitive to prevailing operational and environmental conditions. On reflection, staff should have been prepared more extensively to ensure they understood the rationale for the interventions more clearly.